Provider First Line Business Practice Location Address:
107C STE H EAST WADE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WADESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28091-0107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-695-1728
Provider Business Practice Location Address Fax Number:
704-994-2780
Provider Enumeration Date:
03/14/2007